Explained: Why cases of paediatric asthma dropped drastically during the Covid-19 pandemic

Lockdown restrictions, shut schools, social distancing, mask wearing have made an impact

Covid-19 lockdown measures have seen a huge drop in the difficult to control cases of asthma attacks, not just globally but in India as well, according to some studies. It has taken a pandemic to understand the importance of school-related respiratory viral infections as one of the major factors of asthma exacerbation in children, and how wearing a mask can be a protective measure against this disease, said experts.

Asthma cases plummeted during pandemic

Dr Sundeep Salvi, chair of the Chronic Respiratory Diseases Section, Global Burden of Diseases-India, said that asthma cases plummeted during the pandemic. “Before the pandemic started, over 60% of children who visited a pediatrician in India did so for respiratory symptoms and a large proportion of these were for asthma. With the onset of the Covid-19 pandemic, the number of childhood asthmatics visiting a pediatrician plummeted by over 50 – 60%. This came as a surprise for doctors, as it was feared that the SARS COV-2 virus, being a respiratory predominant virus, would cause worsening of asthma. The shocking reduction in the number of paediatric asthma cases visiting a healthcare facility actually came as a boon…,” Dr Salvi said.

“There was a remarkable change worldwide and a similar trend was noted in India,” Dr Salvi said.

Schools being shut, lockdown restrictions important factors

Lockdown restrictions, schools being shut for in-person classes and social distancing have had important implications for movement and play behaviours, limiting children’s physical activity and reducing exposure to environmental triggers, say experts in their study `Impact of the Covid- 19 pandemic on asthma control among children’ from a caregiver’s perspective, published in the British Medical Journal (BMJ-Open).

The European Respiratory Journal has also published observations from studies in Singapore, where researchers witnessed a sustained reduction in asthma admissions with PCR-proven respiratory viral infections (RVIs) that coincided with the widespread adoption of public health measures during the pandemic. Reduced number of motor vehicles on the road and shutting down of industries, which were major sources of air pollution in cities and towns, must have also contributed by reducing personal exposures to air pollution, said Dr Salvi.

Asthma growing problem in country

Asthma is the most common chronic disease among children and according to WHO, it affected an estimated 262 million people in 2019 and caused 4.61 lakh deaths. Inflammation and narrowing of the small airways in the lungs cause asthma symptoms which can be a combination of cough, wheeze, shortness of breath and chest tightness. Symptoms of asthma are intermittent and are often worse at night or during exercise.

According to the latest Global Burden of Disease (GBD) report, there are an estimated 3.4 crore asthmatics in India, of which around 25% are children. Although India has 11% of global asthma cases, the country accounts for a shocking 42% of all global asthma deaths.

Respiratory viral infections recognised trigger for attacks

Until recently, based on research in the western world, it was believed that asthma was mostly caused and triggered by a whole host of environmental factors, including allergens from plant sources (pollen), animal sources (cats, dogs, horses), dust mites, house dust, deodorants and perfumes. Respiratory viral infections were also a recognised trigger for childhood asthma exacerbations, but did not receive much importance, Dr Salvi said.

According to the expert, a potential explanation for why asthma in children plummeted during the Covid-19 pandemic is that children did not attend school and stayed at home due to the pandemic and lockdown. As a result, there were no respiratory virus infections among children, which would have otherwise happened had the children been going to school.

On an average, a child develops between two to five respiratory viral infections during a year and this becomes the reason for exacerbations among children suffering with asthma. The fact that asthma exacerbations plummeted among children suggests that school-related respiratory viral infections were a major cause of asthma exacerbations in children. Similar observations have been made in other parts of the world.

Pandemic taught importance of hand hygiene, masks

Asthma is a huge and growing problem in India that demands attention by policy makers and healthcare providers. Wearing a mask can be a very useful protective measure against asthma. While schools will eventually reopen, experts like Dr Salvi and others have said this pandemic has highlighted the importance of avoiding respiratory viral infections in schools. Children wearing masks when they attend school even after the pandemic is over will likely be the most effective solution to reduce asthma suffering and exacerbations.

Wearing a mask not only protects against the Covid-19 virus, but will also protect against catching other respiratory viruses. Protection from ambient air pollution will be an added advantage for wearing masks. “We also need to continue with this behavior of hand hygiene even after the pandemic is over,” said Dr Salvi.

Meanwhile, with relaxations in lockdown-like restrictions, paediatricians have noted a slight rise in the number of cases of wheezing. Dr Umesh Vaidya, senior paediatrician and expert member in Pune’s Covid task force, said that this was true last year but with opening up after the lockdown, there are more cases of wheezing .

“Rise in cases is usually a combination of weather and viral infections. Last year, there was a total lockdown and hence there were very few cases. With easing of lockdown restrictions, there has been some social interaction, especially as children play with each other and mild viral infections can trigger wheezing episodes. This month, we have started seeing a rise in cases and at our hospital, there are no spare nebulizers as all have been given to patients,” said Dr Vaidya.

Dr Gaurav Sethi, consultant paediatrician with a special interest in paediatric asthma, said new cases have definitely gone down and episodes of asthma attacks have been low . Extended lockdowns have also led to improved air quality, said Dr Sethi.

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